Neurofibromin/dopamine signaling as a biomarker for cognitive and behavioral problems in children with neurofibromatosis type 1 (nf1)

ABSTRACT

The present disclosure is generally related to neurofibromatosis type 1. More particularly, disclosed herein are methods for detecting behavioral disorders, methods for detecting cognitive impairment, and methods for detecting brain neurofibromin-dependent dopaminergic signaling associated with neurofibromatosis type 1.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application No. 62/181,949, filed on Jun. 19, 2015, the disclosure of which is incorporated by reference in its entirety.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

This invention was made with government support under 5-T32-EY13360, 5-T32-NS007205-33, and 1R01-CA195692-01 awarded by The National Institutes of Health. The Government has certain rights in the invention.

INCORPORATION OF SEQUENCE LISTING

A paper copy of the Sequence Listing and a computer readable form of the Sequence Listing containing the file named “WUSTL015422_ST25.txt”, which is 82,262 bytes in size (as measured in MICROSOFT WINDOWS® EXPLORER), are provided herein and are herein incorporated by reference. This Sequence Listing consists of SEQ ID NO:1-4.

BACKGROUND OF THE DISCLOSURE

The present disclosure relates generally to neurofibromatosis type 1. More particularly, the present disclosure is directed to methods for detecting behavioral disorders, methods for detecting cognitive impairment, and methods for detecting neurofibromin-dependent dopaminergic signaling associated with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is a monogenic neurodevelopmental disorder affecting ˜1 in 2500 individuals worldwide. Greater than 50% of individuals with NF1 exhibit cognitive deficits, which affect scholastic abilities and impact quality of life. These cognitive impairments include specific learning disabilities, attention deficits, autistic-like behaviors and visuospatial learning/memory problems. The specific cognitive symptoms as well as their severity vary greatly among individuals with NF1. Some children with NF1 can have problems with reading or mathematic achievement, while others exhibit deficits in visual perception or response inhibition. There may be cellular and molecular etiologies for these cognitive delays, which may explain why a small number of children respond to targeted therapeutic interventions.

Neurofibromin functions as a negative regulator of RAS and a positive regulator of dopamine homeostasis. High levels of RAS activation and low levels of dopamine have been reported in the brains of Nf1 genetically-engineered mice. Treatments such as lovastin (a RAS inactivator) or dopamine uptake blockers can ameliorate the spatial learning and memory deficits in mice.

A challenge to the management of children with NF1 is the lack of predictive markers to identify individuals with a risk for specific morbidities. Evidence from early-phase NF1 gene mutation studies has suggested that some types of germline NF1 gene mutations may be associated with certain clinical features. Cognitive problems in neurological disorders can be difficult to identify, especially in non-verbal or young children. Accordingly, there exists a need to identify predictive markers for disease phenotypes in NF1 patients.

BRIEF DESCRIPTION OF THE DISCLOSURE

The present disclosure is generally related to neurofibromatosis type 1. More particularly, the present disclosure is directed to methods for detecting behavioral disorders, methods for detecting cognitive impairment, and methods for detecting neurofibromin-dependent dopaminergic signaling associated with neurofibromatosis type 1.

In one aspect, the present disclosure is directed to a method for detecting a behavioral disorder in a subject having or suspected of having neurofibromatosis type 1 (NF1). The method comprises obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a memory defect in a subject having or suspected of having neurofibromatosis type 1 (NF1).

In another aspect, the present disclosure is directed to a method for detecting a cognitive impairment in a subject having or suspected of having neurofibromatosis type 1 (NF1). The method comprises: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a cognitive impairment in a subject having or suspected of having neurofibromatosis type 1 (NF1).

In another aspect, the present disclosure is directed to a method for detecting altered brain neurofibromin-dependent dopaminergic signaling in a subject having or suspected of having neurofibromatosis type 1 (NF1). The method comprises: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a memory defect in a subject having or suspected of having neurofibromatosis type 1 (NF1).

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

The disclosure will be better understood, and features, aspects and advantages other than those set forth above will become apparent when consideration is given to the following detailed description thereof. Such detailed description makes reference to the following drawings, wherein:

FIGS. 1A-1E depict the influence of Nf1 germline mutations on tumor formation. FIG. 1A is a schematic illustration of the mouse Nf1 gene and summary of the engineered Nf1 mouse germline mutations with genotyping results. Alternate exons and the RAS-GAP domain are indicated. The position of the three introduced germline mutations is depicted above exons 18, 21 and 31. FIG. 1B (top panel) are photographs showing increased optic nerve volumes in FMC and F18C optic nerves compared to controls while no significant changes were detected between F21C and controls; (bottom panel) Hematoxylin and eosin staining of optic nerves reveal hypercellularity, increased mitotic figures and nuclear atypia in FMC and F18C with a significant increase in cell number in F18C mice. FIG. 1C depicts increased GFAP (top) and Ki67 (bottom) immunoreactivity in F18C mice compared to FMC mice. FIG. 1D depicts immunostaining with Iba1 demonstrating a significantly increased number of microglia in the optic nerve of FMC and F18C mice compared to controls. No significant difference was shown in microglia number between F21C and WT controls. Furthermore, F18C mice had significantly more microglia than FMC mice. FIG. 1E depicts an increase in the percentage of TUNEL⁺ cells (top panel), lower percentage of Brn3a⁺ cells (middle panel) and thinning of RNFL (SMI-32 immunostaining) in F18C mice as compared to FMC mice as well as F21C and controls. Scale bar, 100 μm. All data are represented as means±s.e.m.

FIG. 2A-2D depict the regulation of microglial activation and infiltration by Nf1 germline mutation. FIG. 2A (top panel) depicts increased pJNK immunoreactivity in FMC and F18C optic nerves compared to FF controls and F21C optic nerves; (bottom panel) depicts immunofluorescent staining revealing pJNK staining in Iba1 positive cells. FIG. 2B depicts increased CCL5 immunostaining in FMC and F18C optic nerves. FIG. 2C depicts elevation of pAkt.308 only in F18C optic nerves compared to F21C, FMC optic nerves and FF controls. FIG. 2D depicts immunostaining with Iba1 revealing significantly increased number of microglia in Nf1^(+/st18) optic nerves compared to WT (Nf1^(+/+)), Nf1^(+/sp21) and Nf1^(+/−) mice. Scale bar 100 μm. Data are represented as means±s.e.m. (***P<0.0001; One-way ANOVA with Bonferroni post-test).

FIGS. 3A-3C depict NF1 germline mutation dependence of neuronal neurofibromin expression. FIG. 3A depicts immunoblot analysis of neurofibromin in hippocampi of wild-type (Nf1^(+/+); WT) and heterozygous mutant Nf1 mice: Nf1^(+/sp21), Nf1^(+/−) and Nf1^(+/st18). Neurofibromin expression was significantly reduced by 39%, 50% and 76% in Nf1^(+/sp21), Nf1^(+/−) and Nf1^(+/st18) mice, respectively, compared to controls. α-tubulin was used as an internal loading control. FIG. 3B depicts elevation of RAS activity (RAS-GTP) in Nf1^(+/sp21), Nf1^(+/−) and Nf1^(+/st18) hippocampi compared to controls. Total RAS was used as a loading control. FIG. 3C depicts reduction in cAMP levels in Nf1^(sp21/+), Nf1^(+/−) and Nf1^(+/st18) hippocampi compared to WT controls.

FIGS. 4A-4F depict elicitation of memory deficit in Nf1+/st18 mice by Nf1 germline mutation. FIG. 4A depicts the decrease in dopamine levels in all Nf1 mutant mice. Dopamine was reduced by 38%, 50% and 64% in Nf1^(+/sp21), Nf1^(+/−) and Nf1^(+/st18) hippocampi, respectively, compared to WT controls. FIG. 4B depicts the decrease in DARPP-32 activity (phosphorylation) by 44% in Nf1^(+/sp21), 51% in Nf1^(+/−) and 77% in Nf1^(+/st18) hippocampi, compared to controls. FIGS. 4C & 4D. Left panel: All mice preferentially occupied the target (Tgt) quadrant of the water maze. The dashed line represents chance occupancy of any quadrant. Right panel: Nf1^(+/st18) mice spent significantly less time in the target quadrant compared to their WT littermate controls (Nf1^(+/+)). Nf1^(+/sp21) mice showed no memory deficit in the Morris water maze. FIGS. 4E & 4F depict the correlation of relative neurofibromin expression and DA levels (R2=0.9748) (FIG. 4E) or pDARPP-32 levels (R2=0.9835) (FIG. 4F) in Nf1^(+/−) hippocampi. All data are represented as means±s.e.m. (FIGS. 4A-4B: ***P<0.0001; *P<0.01; One-way ANOVA with Bonferroni post-test. FIG. 4C: ***P<0.0001; Two-way ANOVA with Bonferroni post-test; *P<0.01; Student's t-test).

FIGS. 5A-5H depict prediction of brain dopaminergic signaling with blood biomarkers. FIG. 5A depicts a Neurofibromin immunoblot revealing a reduction in neurofibromin expression in white blood cells (WBC) of Nf1^(+/sp21) (40%), Nf1^(+/−) (50%) and Nf1^(+/st18) (70%) mice compared to WT controls (Nf1^(+/+)). FIG. 5B depicts the correlation of relative neurofibromin expression detected in hippocampi and WBC (R2=0.9700). FIG. 5C depicts the decrease of dopamine (DA) levels in Nf1^(+/sp21) (40%), Nf1^(+/−) (50%) and Nf1^(+/st18) (60%) WBC compared to WT controls. FIG. 5D depicts the correlation of relative neurofibromin expression and DA levels in WBC samples (R2=0.9881). FIG. 5E depicts the correlation of relative DA levels detected in hippocampi and WBC (R2=0.9015). FIG. 5F depicts the decrease of DARPP-32 phosphorylation in Nf1^(+/sp21) (40%), Nf1^(+/−) (50%) and Nf1^(+/st18) (70%) WBC compared to wild-type controls. FIG. 5G depicts the correlation of relative neurofibromin expression and DARPP-32 phosphorylation in WBC (R2=0.9891). FIG. 5H depicts the correlation of relative DARPP-32 phosphorylation detected in hippocampi and WBC (R2=0.9162). Data are represented as means±s.e.m. (***P<0.0001; One-way ANOVA with Bonferroni post-test).

FIGS. 6A & 6B depict the effect of all germline Nf1 mutations on astrocyte proliferation. FIG. 6A depicts immunoblot analysis of neurofibromin FIG. 6B are graphs depicting fold change in proliferation. Astrocyte proliferation was increased upon Nf1 gene inactivation (Cre) in all germline mutation bearing astrocytes compared to heterozygous control astrocytes (LacZ). Data are represented as means±s.e.m. (**P<0.001; *P<0.005; Student's t-test).

FIGS. 7A & 7B depict activation of Nf1-mTOR pathway in FMC and F18C optic gliomas. FIG. 7A depicts immunostaining with pAkt^(Ser473) (images in left panel) and percent p-AKT^(Ser473+) cells (graph in right panel) revealing significantly higher immunoreactivity in optic nerves of FMC and F18C animals relative to F21C and FF controls. FIG. 7B depicts immunostaining with p-S6^(Ser240-244) (images in left panel) and percent p-S6^(Ser240-244+) cells (graph in right panel) revealing significantly higher immunoreactivity in optic nerves of FMC and F18C animals relative to F21C and FF controls. Data are represented as means±s.e.m. (**P<0.001; *P<0.0.01; One-way ANOVA with Bonferroni post-test).

FIG. 8 depicts higher microglia infiltration in Nf1^(+/−st18) hippocampi. Immunostaining (images in left panel) and Iba1⁺ cells (graph in right panel) with Iba1 reveals significantly higher number of Iba1 positive microglia in the hippocampi of Nf1^(+/−st18) mice compared to Nf1^(+/+) (WT), Nf1^(+/sp21) and Nf1^(+/−) mice. Data are represented as means±s.e.m. (**P<0.001; *P<0.0.01; One-way ANOVA with Bonferroni post-test).

FIGS. 9A-9D depict behavioral analysis of Nf1^(+/sp21) and Nf1^(+/st18) mice, Nf1^(+/st18) mice, WT mice and Nf1^(+/sp21) mice. Nf1^(+/sp21) and W^(+/st18) WT mice (FIG. 9A) and Nf1^(+/st18) mice (FIG. 9B), WT mice (FIG. 9C) and Nf1^(+/sp21) mice spent similar time swimming, covered a similar total distance, and exhibited swimming speeds during the cued (FIGS. 9A & 9C) and place (FIGS. 9B & 9D) training trials.

FIGS. 10A-10F depict the effect of Nf1 germline mutation on Neurofibromin/pDARPP-32 dependent spatial memory. FIG. 10A depicts immunoblot of neurofibromin in hippocampi of wild-type (FF), heterozygous null Nf1^(GFAP) flox/sp21, (F21C) and Nf1^(GFAP) flox/st18 (F18C) and null Nf1^(GFAP) flox/− (FMC) mice normalized to α-tubulin. Neurofibromin expression was significantly reduced in F21C, FMC and F18C mice hippocampi, compared to controls. FIG. 10B depicts elevation of RAS-GTP levels in F21C, FMC and F18C hippocampi, compared to WT controls. There was no significant difference between F21C, FMC and F18C hippocampi. FIG. 10C depicts reduced cAMP levels in F21C, FMC and F18C hippocampi compared to WT controls. There was no significant difference between F21C, FMC and F18C hippocampi. FIG. 10D (left panel) depicts the occupation of the target quadrant of the water maze compared to quadrants opposite (Opp) from, to the left of, and to the right of the target quadrant. All mice preferentially occupied the target (Tgt) quadrant of the water maze compared to the quadrants opposite (Opp), left and right to it. The dashed line represents chance occupancy of any quadrant (15 sec). FIG. 10D (right panel) depicts the time mice spent in the target quadrant. F18C mice spent significantly less time in the target quadrant compared to F21C and FF controls. The dashed line represents time spent in the target quadrant by FMC mice. FIG. 10E depicts the reduction in dopamine levels in F21C, FMC and F18C hippocampi compared to controls. FIG. 10F depicts the decrease in DARPP-32 phosphorylation in F21C, FMC and F18C hippocampi compared to controls. All data are represented as means±s.e.m. (***P<0.0001; **P<0.001; One-way/two-way ANOVA with Bonferroni post-test).

FIGS. 11A & 11B depict the behavioral analysis of Nf1 CKO mice. WT, F21C and F18C mice spent similar time swimming, covered a similar total distance and exhibited similar swimming speeds during the cued (FIG. 11A) and place (FIG. 11B) training trials.

FIG. 12A-12C depict that germline NF1 gene mutations result in differences in neurofibromin expression in NF1-patient fibroblasts. FIG. 12A is a neurofibromin immunoblot of NF1-patient fibroblasts demonstrating two groups showing reductions of neurofibromin expression. Group 1 patients have a <25% reduction in neurofibromin expression (n=4) and Group 2 patients have a >70% reduction in neurofibromin expression (n=7) when analyzed versus sex- and age-matched control individuals. Tubulin was used as an internal protein loading control. FIG. 12B depicts elevation of RAS activity in all NF1-patient fibroblasts. FIG. 12C is a schematic representation of the NF1 gene with the identified NF1-patent mutations and summary of NF1-patient germline NF1 gene mutations, demographic information and genotyping results. The number of exon mutated is indicated above the mutation location. Light and dark boxes indicate alternate exons. Horizontal bars represent the length of the predicted transcribed mRNA. TGD, total genomic deletion; FS, frame shift mutation. All data are represented as means±SEM (*P<0.0001, one-way ANOVA with Bonferroni post-test).

FIG. 13A-13D depict that germline NF1 gene mutations promote differential neurofibromin expression in NF1-patient-derived iPSCs. FIG. 13A depicts immunostaining of iPSC cultures with stem cell-specific antibodies confirming the pluripotent nature of the cultured iPSCs. Scale bar, 50 μm. FIG. 13B depicts bright-field images of representative iPSCs. Scale bar, 100 μm. FIG. 13C depicts the reduction of neurofibromin expression in Group 2 NF1-patient-derived iPSCs. FIG. 13D depicts the elevated RAS activity levels (RAS-GTP) in all NF1-patient-derived iPSCs relative to control iPSC lines. All data are represented as means±SEM (*P<0.0001, one-way ANOVA with Bonferroni post-test).

FIG. 14A-14D depict that germline NF1 gene mutations promote differential neurofibromin expression in NF1-patient-derived NPCs. FIG. 14A are bright-field images and immunostaining of NPC cultures with the SMI-312 pan-axonal (neuronal) antibody. Scale bar left panel, 100 μm. Scale bar right panel, 50 μm. FIG. 14B depicts that neurofibromin expression was only significantly different in Group 2 NF1-patient samples relative to control NPCs. FIG. 14C depicts the elevated RAS activity levels in all NF1-patient NPCs. FIG. 14D depicts the decreased cAMP levels in all NF1-patient NPCs relative to control NPCs.

FIG. 15A-15D depict that germline NF1 gene mutations regulate dopamine signaling in a gene dose-dependent manner in NF1-patient NPCs. FIG. 15A depicts the reduction of dopamine (DA) levels in Group 2 NF1-patient samples relative to control NPCs. FIG. 15B depicts the relationship between neurofibromin expression and DA levels. FIG. 15C depicts the reduction of DARPP-32 activity (phosphorylation) only in Group 2 NF1-patient samples relative to control NPCs. FIG. 15D depicts the relationship between neurofibromin expression and DARPP-32 phosphorylation. All data are represented as means±SEM (*P<0.0001, one-way ANOVA with Bonferroni post-test).

DETAILED DESCRIPTION

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the disclosure belongs. Although any methods and materials similar to or equivalent to those described herein can be used in the practice or testing of the present disclosure, the preferred methods and materials are described below.

Disclosed are methods for detecting behavioral disorders, methods for detecting memory defects, and methods for detecting hippocampal neurofibromin-dependent dopaminergic signaling associated with neurofibromatosis type 1.

As used herein, “a subject in need thereof” refers to a subject having, susceptible to or at risk of a specified disease, disorder, or condition. More particularly, in the present disclosure the methods of screening biomarkers is to be used with a subset of subjects who have, are susceptible to or are at an elevated risk for experiencing behavioral disorders, memory defects, and/or altered brain neurofibromin-dependent dopaminergic signaling associated with neurofibromatosis type 1. Such subjects can be susceptible to or at elevated risk for behavioral disorders, memory defects, and/or altered brain neurofibromin-dependent dopaminergic signaling due to family history, age, environment, and/or lifestyle.

Based on the foregoing, because some of the method embodiments of the present disclosure are directed to specific subsets or subclasses of identified subjects (that is, the subset or subclass of subjects “in need” of assistance in addressing one or more specific conditions noted herein), not all subjects will fall within the subset or subclass of subjects as described herein for certain diseases, disorders or conditions.

As used herein, “susceptible” and “at risk” refer to having little resistance to a certain disease, disorder or condition, including being genetically predisposed, having a family history of, and/or having symptoms of the disease, disorder or condition.

As used herein, “expression level of a biomarker” refers to the process by which a gene product is synthesized from a gene encoding the biomarker as known by those skilled in the art. The gene product can be, for example, RNA (ribonucleic acid) and protein. Expression level can be quantitatively measured by methods known by those skilled in the art such as, for example, northern blotting, amplification, polymerase chain reaction, microarray analysis, tag-based technologies (e.g., serial analysis of gene expression and next generation sequencing such as whole transcriptome shotgun sequencing or RNA-Seq), Western blotting, enzyme linked immunosorbent assay (ELISA), and combinations thereof.

As used herein, “a reference expression level of a biomarker” refers to the expression level of a biomarker established for a subject without neurofibromatosis type 1, expression level of a biomarker in a normal/healthy subject without neurofibromatosis type las determined by one skilled in the art using established methods as described herein, and/or a known expression level of a biomarker obtained from literature. The reference expression level of the biomarker can also refer to the expression level of the biomarker established for any combination of subjects such as a subject without neurofibromatosis type 1, expression level of the biomarker in a normal/healthy subject without neurofibromatosis type 1, and expression level of the biomarker for a subject without neurofibromatosis type 1 at the time the sample is obtained from the subject, but who later exhibits without neurofibromatosis type 1. The reference expression level of the biomarker can also refer to the expression level of the biomarker obtained from the subject to which the method is applied. As such, the change within a subject from visit to visit can indicate an increased or decreased risk for neurofibromatosis type 1. For example, a plurality of expression levels of a biomarker can be obtained from a plurality of samples obtained from the same subject and used to identify differences between the pluralities of expression levels in each sample. Thus, in some embodiments, two or more samples obtained from the same subject can provide an expression level(s) of a blood biomarker and a reference expression level(s) of the blood biomarker.

In one aspect, the present disclosure is directed to a method for detecting a behavioral disorder in a subject having or suspected of having neurofibromatosis type 1 (NF1). The method includes: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a behavioral disorder in a subject having or suspected of having neurofibromatosis type 1 (NF1).

Suitably, the expression level of the neurofibromin in the sample obtained from the subject is reduced when analyzed against the reference expression level. In an embodiment where the expression level of neurofibromin is obtained from a hippocampal sample as detected by Western blot analysis, the expression level of neurofibromin can be reduced by greater than 70% versus a reference expression level of neurofibromin obtained from a hippocampal sample obtained from a healthy subject. In another embodiment where the expression level of neurofibromin is obtained from white blood cells from a blood sample as detected by Western blot analysis, the expression level of neurofibromin can be reduced by greater than 70% versus a reference expression level of neurofibromin obtained from white blood cells from a blood sample obtained from a healthy subject.

The method can further include identifying an expression level of dopamine Suitably, the expression level of the dopamine in the sample obtained from the subject is reduced when analyzed against the reference expression level. In an embodiment where the expression level of dopamine is obtained from a hippocampal sample as detected by Western blot analysis, the expression level of dopamine can be reduced by greater than 70% versus a reference expression level of dopamine obtained from a hippocampal sample obtained from a healthy subject. In an embodiment where the expression level of dopamine is obtained from white blood cells from a blood sample as detected by Western blot analysis, the expression level of dopamine can be reduced by greater than 70% versus a reference expression level of dopamine obtained from white blood cells from a blood sample obtained from a healthy subject.

The method can further include identifying phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPPP-32). Suitably, the phosphorylation the DARPPP-32 in the sample obtained from the subject is reduced when analyzed against phosphorylation of DARPPP-32 obtained from a hippocampal sample obtained from a healthy subject. In an embodiment where the expression level of neurofibromin is obtained from a hippocampal sample as detected by Western blot analysis, the expression level of DARPPP-32 can be reduced by greater than 70% versus a reference expression level of DARPPP-32 obtained from a hippocampal sample obtained from a healthy subject. In an embodiment where the phosphorylation of DARPPP-32 is obtained from white blood cells from a blood sample as detected by Western blot analysis, the phosphorylation of DARPPP-32 can be reduced by greater than 70% versus a phosphorylation of DARPPP-32 obtained from white blood cells from a blood sample obtained from a healthy subject.

In another embodiment, the method can further include detecting a point mutation in an exon of the Nf1 gene. The Nf1 gene can be a human Nf1 gene (see, Accession No. NM_00104292.2) and a mouse Nf1 gene (see, Accession No. NM_010897.2). Suitable exons in which a point mutation can be detected can be exon 18, exon 21, and combinations thereof. A particularly suitable point mutation to be detected in exon 18 is c.2041C>T of the human Nf1 gene (see, Accession No. NM_00104292.2). A particularly suitable point mutation to be detected in exon 21 is c.2542G>C of the human Nf1 gene (see, Accession No. NM_00104292.2).

Suitable samples can be brain, hippocampi, peripheral white blood cells, skin, and combinations thereof.

Suitable subjects can be any vertebrate species. Particularly suitable subjects can be humans and rodents. Suitable humans can be children. Particularly suitable human children include children having or suspected of having neurofibromatosis type 1 (NF1). Particularly suitable rodents include mice.

In another aspect, the present disclosure is directed to a method for detecting a cognitive impairment in a subject having or suspected of having neurofibromatosis type 1 (NF1). The method includes: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a cognitive impairment in a subject having or suspected of having neurofibromatosis type 1 (NF1).

Suitably, the expression level of the neurofibromin in the sample obtained from the subject is reduced when analyzed against the reference expression level as described herein.

The method can further include identifying an expression level of dopamine Suitably, the expression level of the dopamine in the sample obtained from the subject is reduced when analyzed against the reference expression level as described herein.

The method can further include identifying phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPPP-32). Suitably, the phosphorylation of DARPPP-32 in the sample obtained from the subject is reduced when analyzed against the reference expression level as described herein.

The method can further include detecting a point mutation in an exon of the Nf1 gene. The Nf1 gene can be a human Nf1 gene (see, Accession No. NM_00104292.2) and a mouse Nf1 gene (see, Accession No. NM_010897.2). Suitable exons in which a point mutation can be detected can be exon 18, exon 21, and combinations thereof. A particularly suitable point mutation to be detected in exon 18 is c.2041C>T of the human Nf1 gene (see, Accession No. NM_00104292.2). A particularly suitable point mutation to be detected in exon 21 is c.2542G>C of the human Nf1 gene (see, Accession No. NM_00104292.2).

Suitable samples can be brain, hippocampi, peripheral white blood cells, skin, and combinations thereof.

Suitable subjects can be any vertebrate species. Particularly suitable subjects can be humans and rodents as described herein. Particularly suitable human children include children having or suspected of having neurofibromatosis type 1 (NF1).

Cognitive impairments can be selected from learning disabilities, attention deficits, autistic-like behaviors, visuospatial learning/memory problems and combinations thereof.

In another aspect, the present disclosure is directed to a method for detecting brain neurofibromin-dependent dopaminergic signaling in a subject having or suspected of having neurofibromatosis type 1 (NF1). The method includes: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a memory defect in a subject having or suspected of having neurofibromatosis type 1 (NF1).

In one embodiment, the present disclosure is directed to a method for detecting hippocampal neurofibromin-dependent dopaminergic signaling in a subject having or suspected of having neurofibromatosis type 1 (NF1).

Suitably, the expression level of the neurofibromin in the sample obtained from the subject is reduced when analyzed against the reference expression level as described herein.

The method can further include identifying an expression level of dopamine Suitably, the expression level of the dopamine in the sample obtained from the subject is reduced when analyzed against the reference expression level as described herein.

The method can further include identifying phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPPP-32). Suitably, the phosphorylation of DARPPP-32 in the sample obtained from the subject is reduced when analyzed against the reference expression level as described herein.

The method can further include detecting a point mutation in an exon of the Nf1 gene. The Nf1 gene can be a human Nf1 gene (see, Accession No. NM_00104292.2) and a mouse Nf1 gene (see, Accession No. NM_010897.2). Suitable exons in which a point mutation can be detected can be exon 18, exon 21, and combinations thereof. A particularly suitable point mutation to be detected in exon 18 is c.2041C>T of the human Nf1 gene (see, Accession No. NM_00104292.2). A particularly suitable point mutation to be detected in exon 21 is c.2542G>C of the human Nf1 gene (see, Accession No. NM_00104292.2).

Suitable samples can be brain, hippocampi, peripheral white blood cells, skin, and combinations thereof.

Suitable subjects can be any vertebrate species. Particularly suitable subjects can be humans and rodents as described herein. Particularly suitable human children include children having or suspected of having neurofibromatosis type 1 (NF1).

EXAMPLES Materials and Methods

Mice. All animals were maintained on an inbred C57BL/6 background using a 12 hour light/dark cycle with ad libitum access to food and water. Heterozygous Nf1 mice were generated with one wild-type copy of the Nf1 gene and one copy containing either a missense mutation in exon 21 (corresponding to the human c.2542G>C NF1 gene mutation; p.G848R) (Nf1^(+/sp21)), a nonsense mutation in exon 18 (corresponding to the human c.2041C>T NF1 gene mutation; p.R681X) (Nf1^(+/st18)), or a null inactivating allele created by the insertion of a neomycin cassette within exon 31 (Nf1^(+/neo31), Nf1^(+/−)). Conditional knockout mice were generated with the sp21, neo31 or st18 mutation as the germline Nf1 allele, with somatic Nf1 gene inactivation resulting from Cre-mediated excision of an Nf1flox allele in neuroglial progenitor cells. The resulting strains included Nf1^(GFAP) flox/sp21 (Nf1 flox/sp21; GFAP-Cre, F21C), Nf1^(GFAP) flox/− (Nf1 flox/neo31; GFAP-Cre, FMC and Nf1^(GFAP) flox/st18 (Nf1 flox/st18; GFAP-Cre, F18C). Littermate Nf1^(+/+) and Nf1^(flox/flox) (FF) mice were used as controls. All experiments were performed on 3-month-old animals, unless otherwise stated, under active Animal Studies Committee protocols at the Washington University School of Medicine.

White Blood Cell Isolation.

1-3 mL of fresh mouse peripheral blood was collected from 3-month-old mice by retro-orbital bleed into EDTA-coated vials. An equal volume of PBS was added to the blood before the solution was layered over 3 mL of Ficoll-Paque and fractionated by centrifugation to isolate the white blood cell (WBC) layer. WBCs were further washed by centrifugation, and the resulting cell pellet was snap-frozen and stored at −80° C. A minimum of 10 animals per genotype was used for WBC protein analysis.

Western Blotting, Immunohistochemistry and Immunofluorescence.

Western blotting was performed on snap-frozen hippocampi or WBC pellets, lysed in RIPA buffer supplemented with protease inhibitors as previously described (Brown et al, 2010) using appropriate primary antibodies (Table 1), secondary horseradish peroxidase-conjugated antibodies (Sigma, St. Louis, Mo.) and ECL (Fisher) chemiluminescence. Western signal band intensity was quantified using ImageJ Software (National Institutes of Health, USA) Immunohistochemistry and immunofluorescence were performed as previously described (Brown et al, 2010), on mice transcardially perfused with 4% PFA (Sigma) in 0.1 M sodium phosphate buffer (pH 7.4) and post-fixed in 4% PFA prior to paraffin embedding. For some immunofluorescence experiments (Brn3a, Cc15), amplification of the antibody signal was performed using the TSA Cy3 Plus system (Perkin Elmer) as previously described (Kaul, Toonen 2014). A minimum of 5 animals per genotype was used for these analyses.

TABLE 1 Primary Antibodies. Antibody Source Host animal Dilution Application Neurofibromin Santa Cruz (sc-67) Rabbit 1:100 WB Phospho-DARPP-32 Santa Cruz Goat 1:100 WB (Thr34) DARPP-32 Cell Signaling Rabbit 1:500 WB RAS (Clone RAS10) Millipore Mouse 1:1,000 WB α-Tubulin Life Technologies Mouse 1:20,000 WB Iba1 Wako Rabbit 1:1,000 IHC Phospho-Akt (Thr308) Cell Signaling Rabbit 1:1000 IHC Phospho-Akt (Ser473) Cell Signaling Rabbit 1:1000 IHC phospho-S6 S240/244 Cell Signaling Rabbit 1:1000 IHC Phospho-SAPK/JNK Cell Signaling Rabbit 1:1000 IHC Ccl5 Lifespan Rabbit 1:150 IF Biosciences GFAP Invitrogen Rat 1:200 IHC Brn3a Santa Cruz Mouse 1:500 IF SMI-32 Covance Mouse 1:500 IHC cAMP Abcam Mouse 1:1000 IF Ki67 IHC

RAS Activity, cAMP and Dopamine Assays.

Snap-frozen adult mouse hippocampi were used to perform RAS activity (Millipore), dopamine (Rocky Mountain Diagnostics) and cAMP (Enzo Life Sciences) assays. Active Ras (Ras-GTP) was detected by Raf1-RBD immunoprecipitation using the RAS activation kit according to the manufacturer's instructions. Samples processed for cAMP and dopamine ELISA assays were homogenized in ice-cold 0.1M HCl pH7.4 and levels quantitated as previously reported (Anastasaki et al., 2015 PMID: 25788518, Diggs-Andrews et al., 2014).

Behavioral Testing.

For Morris Water Maze testing, mice underwent trial sessions for two consecutive days, where they were trained in a water maze with a visibly-marked, but variably-placed, platform (cued trials). Additionally, mice were trained for 5 consecutive days in a water maze with a hidden platform that had a static location (place trials). Memory retrieval was analyzed in the same water maze 1 hour after the end of the last place trial on the third and fifth days, when the hidden platform was removed. The escape path length (distance traveled to platform) as well as the swimming speed and latency (swimming time to platform) were recorded for all training and probe trials. The time spent in the water maze quadrant containing the former location of the platform (target quadrant) and the spatial bias for the target quadrant (time in target versus other quadrants) were used as readouts for the probe trials. Ten animals per genotype were used for these analyses.

Primary Astrocyte Culture and Proliferation Assay.

Primary astrocytes were generated from the brainstems of postnatal day 0-1 mouse pups and maintained in astrocyte growth medium (Dulbecco's Modified Eagle's medium (DMEM) containing 10% fetal bovine serum and 0.01% penicillin/streptomycin). To inactivate the conditional Nf1^(flox) allele, astrocytes (passage 1) were infected with adenovirus type 5 (Ad5) containing Cre recombinase (Ad5-Cre) (University of Iowa Gene Transfer Vector Core, Iowa City, Iowa). Control infections employed Ad5 containing β-galactosidase (Ad5-LacZ). 4 days post-infection, astrocytes were passaged and serum-starved for 48 h prior to Western blotting and proliferation analysis. Astrocyte proliferation was assessed using the BrdU Cell Proliferation ELISA kit (Roche) following manufacturer's instructions. Briefly, 6,000 serum-starved astrocytes were labeled with BrdU for 18 hours followed by a 2-hour incubation in peroxidase-conjugated anti-BrdU antibody. Proliferating astrocytes were identified using a colorimetric substrate reaction measured at 450 nM on a spectrophotometer (BioRad).

Statistical Analysis.

All statistical analyses were performed using GraphPad Prism 5 software (GraphPad Software). Unpaired two-tailed Student's T-tests were used for experiments analyzing data between two groups. One-way or two-way ANOVA with Bonferroni post-test correction analyses were employed for multiple comparisons.

Optic Nerve Volume Measurements.

Optic nerves with an intact chiasm were microdissected following transcardial perfusion. Optic nerves were photographed and diameters measured at the chiasm (˜150, ˜300, and ˜450 microns anterior to the chiasm) to generate optic nerve volumes. A minimum of five animals per genotype was employed for the measurement of optic nerves.

Retinal Nerve Fiber Layer Measurements.

Retinal nerve fiber layer (RNFL) thickness was quantitated using the average of 15 measurements of SMI-32-stained axons 0-250 μm proximal to the optic nerve head (ImageJ software). A minimum of five animals per genotype was used for this analysis.

Example 1

In this Example, the effect of specific Nf1 germline mutations on optic glioma formation was analyzed.

C57/B16 mice that harbor germline point mutations in exons 21 (sp21) and 18 (st18) were generated. Employing the GFAP-Cre driver line, we generated two new conditional knockout (CKO) mice that have a single germline mutation in all cells and an additional somatic inactivating mutation in neuroglial cells: 2542G>C (exon 21; Nf1 flox/21 GFAP-Cre; F21C) and 2041C>T (exon 18; Nf1 flox/18 GFAP-Cre; F18C) (FIG. 1A). Direct volume measurements of optic nerves revealed a 43% increase in optic nerve volumes of F18C mice, similar to Nf1^(flox/−) GFAP-Cre (FMC; Bajenaru et al, 2003 PMID: 14695164) mice (48% increase), whereas there was no significant increase in optic nerve volume of F21C mice compared to FF controls (FIG. 1B). Additionally, hematoxylin and eosin staining revealed hypercellularity (1.6 fold increase in cell number), mitotic figures and atypical cells in F18C optic nerves, whereas F21C optic nerves were indistinguishable from controls (FIG. 1B). Similarly, an increase in GFAP immunoreactivity was only found in FMC and F18C optic nerves compared to FF controls (FIG. 1C). GFAP immunoreactivity was significantly elevated in F18C compared to FMC mice. Together, these data suggest that tumor formation is Nf1 germline mutation-dependent.

Most children with NF1-OPG come to clinical attention due to vision loss. In fact, up to half of children with NF1-OPG succumb to loss of visual acuity. Previous studies from have shown differential loss of retinal ganglion cells (RGCs) due to tumor aggressiveness (Kaul et al, 2014 PMID 25246427). That the increased tumor growth in F18C mice may have worsened retinal dysfunction was determined. In that respect, a 1.5 fold increase in TUNEL⁺ cells and a 27%±6.5 reduction of Brn3a+ retinal ganglion cells in F18C retinae was found as compared to FMC and FF controls (FIG. 1E). Moreover, optical coherence tomography (OCT) has been a useful, non-invasive clinical tool to demonstrate retinal nerve fiber layer (RNFL) thinning in NF1 patients with loss of visual acuity. RNFL thickness was visualized by axon immunostaining for SMI-32 in F18C mice compared to FMC, F21C and controls. Thinning was identified only in FMC and F18C mice (FIG. 1E). F18C had further RNFL thinning compared to FMC mice. Taken together, these data suggest that visual acuity is highly sensitive to Nf1 germline mutation.

Ki67 immunostaining revealed a significant increase in proliferation in F18C mice compared to FF controls (2.2-fold) as well as to FMC mice (2.17-fold) (FIG. 1C). Conversely, there was no significant increase in Ki67+ cells in F21C optic nerves. To further determine if astrocyte proliferation was impacted by sp21 and st18 germline mutations upon Nf1 inactivation in a cell-autonomous manner, primary astrocytes were cultured from heterozygous Nf1^(flox/Sp21), Nf1^(flox/−), Nf1^(flox/Sp18), brainstem tissue and were either infected with a control virus containing β-galactosidase (LacZ) or Cre recombinase (Cre) (LacZ) (FIG. 6). Upon bi-allelic mutation of Nf1 (F21C; FMC; F18C), astrocyte proliferation was similarly increased in all three groups (1.3-2-fold). Collectively, these data suggest that the specific heterozygous glioma microenvironment is responsible for the observed increase in proliferation in F18C mice in vivo compared to control and F21C mice.

Example 2

In this Example, the effect of Nf1 germline mutation on microglial infiltration and signaling was analyzed.

Non-neoplastic cells in the optic glioma microenvironment, such as Nf1^(+/−) microglia, contribute to tumor formation, growth and maintenance by promoting astrocyte proliferation. In accordance with these findings, an increase in F18C optic nerve microglia (97%±7) was found, but not in F21C optic nerves compared to FMC mice (FIG. 1D) indicating that the specific Nf1 germline mutation contributes to microglia activation and infiltration. Since inactivation of the second Nf1 allele promoted higher proliferation in all astrocyte cultures irrespective if the Nf1 germline mutation (FIG. 6), whether optic nerve tumor formation in FMC and F18C mice is dependent on microglial infiltration and activation rather than astrocyte proliferation was analyzed. Previous studies have revealed that JNK pathway activation (phospho JNK) in microglia is critical for optic nerve formation and maintenance Immunohistochemical staining showed increased levels of pJNK in optic nerve gliomas of FMC and F18C animals compared to controls (FIG. 2A). Similar to Iba1 staining, F18C optic nerves exhibited significantly higher JNK activation than FMC mice. Additionally, recently published work revealed that tumor associated microglia secrete CLL5 in order to promote glioma formation. As such, significantly elevated CCL5 (FIG. 2B) was observed in F18C when compared to FMC optic nerve gliomas. Finally, CCL-5 can promote activation of Akt through phosphorylation of Ser308. Since this site is phosphorylated independently of the RAS-mTOR pathway which is activated in FMC optic gliomas (FIG. 7), activation of pAkt^(Ser308) in optic nerves of the three mouse models was examined. pAkt^(Ser308) was only significantly elevated (2.9-fold) in F18C optic nerves (FIG. 2C), indicating that the Nf1 St18 mutation promotes tumor formation and increased microglia infiltration in an Nf1-pJNK-CCL5-pAkt³⁰⁸-dependent manner.

Finally, since microglia are affected by the specific Nf1 germline mutation, microglial infiltration of the optic nerve of mice that harbor only a germline Nf1 mutation: Nf1+/sp21, Nf1+/− and Nf1+/st18 mice were examined. Immunohistochemical staining with Iba1 revealed a significant increase in microglia numbers in the optic nerves (FIG. 2D) only of Nf1+/−st18 animals compared to the other two Nf1 mutant mice and wild-type controls. Moreover, a significantly (P<0.0001) higher number of microglia were observed in the hippocampi of the same animals (FIG. 8). Collectively, these data suggest that microglia infiltration is highly sensitive to the specific Nf1 germline mutation.

Example 3

In this Example, the dependence of Nf1 germline mutation on Neurofibromin expression levels were analyzed.

Similarly to microglia, neurons are highly sensitive to Nf1 germline mutation. As such, NF1 germline mutation impacts neuronal signaling both in human NPCs and mouse hippocampal neurons. To determine the effect of specific Nf1 germline mutations on mouse neurons, neurofibromin expression levels were assayed in hippocampi of Nf1+/sp21, Nf1+/− and Nf1+/st18 animals (FIG. 3A). Western blotting revealed that neurofibromin expression was decreased by 39% in Nf1+/−sp21, 50% in Nf1+/− and 76% in Nf1+/st18 hippocampi.

To further assess whether the specific germline mutation differentially impacted neurofibromin GAP activity in the three Nf1 models RAS activity (RAS-GTP) in adult mouse hippocampi were assayed. RAS activity was increased by 1.8-fold in Nf1+/sp21, 1.7-fold in Nf1+/− and 1.7-fold in Nf1+/st18 hippocampi (FIG. 3B). Since RAS negatively regulates cAMP in Nf1-depleted neurons, cAMP levels were measured in the three mouse models. cAMP levels were decreased by 49% in Nf1+/sp21, 51% in Nf1+/− and 52% in Nf1+/st18 hippocampi (FIG. 3C). Thus, similar to human iPSC-NPs, where RAS-cAMP regulation is NF1 dosage-independent, Nf1-RAS-dependent signaling in CNS mouse neurons was not sensitive to neurofibromin expression levels.

Example 4

In this Example, regulation of spatial memory in mice by neurofibromin was analyzed.

Unlike RAS-driven phenotypes, dopamine (DA) signaling, phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPP-32) is regulated by neurofibromin levels. To this end, DA levels in all Nf1+/− mice were assayed and established that DA was decreased by 38% in Nf1+/sp21, 50% in Nf1+/− and 64% in Nf1+/st18 hippocampi (FIG. 4A), correlating with neurofibromin levels (R²=0.9748) (FIG. 4E). In addition, DARPP-32 activity (pDARPP-32) was decreased by 44%, in Nf1+/sp21, 51% in Nf1+/− and 77% in Nf1+/st18 hippocampi (FIG. 4B), highly correlating with respective neurofibromin expression (R²=0.9835) (FIG. 4F).

Since neurofibromin-dependent dopamine homeostasis and signaling are particularly important in regulating hippocampal-based memory, the performance of Nf1 mutant mice was tested in the Morris water maze (FIGS. 4C & 4D). All animals were able to identify the location of a hidden platform and performed similarly during the “cued” and “place” trials, indicating their intact ability to learn the spatial task (FIG. 9). Moreover, during the “probe” trials of the water maze, Nf1+/sp21 showed no memory deficits compared to WT controls (FIG. 4D). However, Nf1+/st18 mice spent significantly less time in the target quadrant, indicating a deficit in memory retrieval compared to control mice.

Consistent with the findings in hemizygous Nf1+/− mice, inactivation of the second Nf1 allele reduced neurofibromin levels in hippocampi of F21C, FMC and F18C mice by 52%, 73% and 82% respectively compared to FF controls (FIG. 10A). Similarly, DA levels as well as pDARPP-32 were decreased in a neurofibromin dose-dependent manner (FIGS. 10E & 10F). As such, pDARPP-32 levels were decreased by 52% in F21C, 74% in FMC and 83% in F18C hippocampi (FIG. 10F). Moreover, only F18C mice exhibited a spatial memory deficit in the Morris water maze (FIG. 10D), further underscoring the importance of Nf1 germline mutation-driven neurofibromin levels in eliciting behavioral phenotypes.

Example 5

In this Example, Neurofibromin, DA and pDARPP-32 were analyzed as biomarkers of brain neuronal function.

To assess whether peripheral neurofibromin, DA and pDARPP-32 can be used as biomarkers of brain neurofibromin-dependent dopaminergic signaling, white blood cells (WBC) were isolated from peripheral blood of Nf1 heterozygous mice (FIG. 5A). Upon neurofibromin immunoblotting, a significant correlation (R² _(Nf1)=0.9700) between WBC and hippocampal neurofibromin levels was observed (FIG. 5B). Similarly, DA concentration in WBC correlates (FIG. 5C) with WBC neurofibromin (R²=0.9891) (FIG. 5D) and hippocampal DA (R²=0.9015) (FIG. 5E). Finally, DARPP-32 phosphorylation in leukocytes (FIG. 5F) correlates with WBC neurofibromin (R² _(Nf1)=0.9881) (FIG. 5G) and is highly predictive of hippocampal pDARPP-32 (R²=0.9465) (FIG. 5H). Collectively these data establish neurofibromin, DA and pDARPP-32 as novel blood biomarkers of memory defects in Nf1 models.

Example 6

In this Example, neurofibromin levels were analyzed in patients diagnosed with NF1.

Thirteen adult patients diagnosed with NF1 using NIH Consensus Development Conference diagnostic criteria who receive their medical care in the Washington University in St. Louis Children's Hospital Neurofibromatosis Clinical Program were randomly selected and underwent a skin punch biopsy under an approved Human Studies Protocol at the Washington University School of Medicine. A collection of primary fibroblast lines was established using unrelated male (n=5) and female (n=8), as well as from four sex- and age-matched control individuals with no known neurological problems. The specific germline NF1 gene mutation was identified following mutational analysis of DNA and RNA extracted from primary skin fibroblasts using an RNA-core assay complemented with dose analysis by multiplex ligation-dependent probe amplification (MLPA) as described in Messiaen, L.M.W. (In Monogr. Hum. Genet. Karger, Basel, D, K. (ed.), 2008, 16:63-77). NF1 gene nucleotide numbering is based on GenBank reference sequence NM_000267.3 and protein numbering based on NP_000258.1. Exon numbering was assigned according to the NCBI reference sequence along with the known legacy numbering in parenthesis. Nomenclature of the mutations follows the recommendations of the Human Genome Variation Society.

Primary fibroblasts were isolated and cultured from plated skin biopsies collected from patients with NF1 and control individuals for ˜3 weeks. Established lines were reprogrammed into iPSCs using Cyto-Tune technology (Invitrogen). Confluent fibroblasts were infected with a Sendai virus carrying four stem cell reprogramming factors (OCT4, KLF4, SOX2, C-MYC). Six weeks later, iPSC colonies were isolated and their pluripotency confirmed by morphological assessment and the expression of stem cell markers (Nanog, SOX2, OCT4, SSEA-4, TRA-1-60, TRA-1-81). Chromosomal analysis demonstrated normal karyotypes in al lines. Two separate clones from each iPSC line were cultured in Neural Induction Medium (NIM; STEMCELL Technologies) for 5 days. Embryoid body aggregates were plated in NIM on adhesive plates pre-coated with poly-ornithine/laminin Once neural rosettes formed, gentle dissociation and replating facilitated their differentiation into NPCs. A portion of NPCs were differentiated into dopaminergic neurons.

Western blotting was performed using appropriate primary antibodies, secondary horseradish peroxidase-conjugated antibodies (Sigma) and CL (Fisher) chemiluminescence. Neurofibromin (C) antibody (sc-67) was used instead of neurofibromin (N) (sc-68) unless otherwise specified Immunocytochemistry was performed on 4% paraformaldehyde (PFA) fixed cultured cells.

Analysis of neurofibromin levels revealed two distinct subgroups (FIG. 12A): those with minor reductions (Group 1; <25% following normalization to α-tubulin) and those with >70% reductions (Group 2) in neurofibromin expression. This differential neurofibromin expression pattern was observed using both carboxyl- and amino-terminal neurofibromin antibodies and was not related to NF1 RNA expression levels nor to patient sex, age or the in vitro growth conditions employed (with or without serum; data not shown). In all NF1-patient fibroblasts, there was increased RAS activity (FIG. 12B) relative to control patient fibroblasts.

To determine whether these differences in neurofibromin protein expression reflected the underlying germline NF1 gene mutation, all NF1-patient fibroblast samples were analyzed (FIG. 12C). In these individuals, 10 distinct mutations were conclusively identified. The mutations in Group 1 causing mild reductions in neurofibromin expression were frameshift (NF1-1, NF1-5) or nonsense mutations (NF1-8, NF1-10) and the mutations in Group 2 with more dramatic reductions in neurofibromin expression included nonsense mutations (NF1-4, NF1-7, NF1-9, NF1-11) and large microdeletions of the NF1 locus (NF1-6, NF1-12). These data indicate that there is no apparent correlation between the location or nature of the germline NF1 mutation and the level of neurofibromin expression.

Leveraging induced pluripotent stem cell (iPSC) technology and integration-free Sendai virus infection, primary skin fibroblasts were reprogrammed into iPSCs (FIG. 13A). Following immunoblot analysis, the same differential pattern of neurofibromin expression in fibroblasts was observed in the derivative iPSCs (FIG. 13C). Consistent with its established role as negative RAS regulator, the levels of active RAS (RAS-GTP) were elevated in all NF1-iPSCs, irrespective of neurofibromin levels (FIG. 13D), similar to the results in NF1-patient fibroblasts.

To examine the effect of the germline NF1 gene mutation on central nervous system lineage cells, iPSC were directed differentiate into neural progenitor cells (NPCs) (FIG. 14A). The neurofibromin expression observed similarly matched the patterns found in the parental fibroblasts and iPSCs (FIG. 14B). Previous work revealed that neurofibromin positively controls cyclic AMP (cAMP) in a RAS-dependent manner in brain neurons. Consistent with this mechanism, all NF1-NPCs exhibited 2-3-fold elevated RAS-GTP levels (FIG. 14C), irrespective of the germline NF1 gene mutation. Similarly all NF1-NPCs showed significantly reduced cAMP (>50%) levels relative to control NPCs (FIG. 14D).

In contrast, neurofibromin control of DA homeostasis in the striatum and hippocampus is RAS-independent. As such, Group 1 NF1-NPCs exhibited <25% reductions in DA levels, while Group 2 NF1-NPCs had ˜75% reductions (FIG. 15A) Importantly, phosphorylation of the DA downstream effector, DA and cAMP-regulated phosphoprotein of 32 kDa (DARPP-32), was only significantly reduced in Group 2 NF1-NPCs (FIG. 15C). Together, these findings establish a strong relationship between neurofibromin expression and DA homeostasis/signaling (FIGS. 15B and 15D).

In the Examples provided herein, a combination of NF1-patient primary fibroblasts as well as derivative iPSCs and NPCs were employed to explore the mechanistic relationship between the germline NF1 gene mutation and neurofibromin expression/function. The deployment of these unique NF1-patient biospecimens along with Nf1 genetically-engineered mouse strains provided complementary evidence relevant to disease heterogeneity, biomarker implementation and risk assessment in this common neurogenetic condition. Germline NF1 gene mutations result in dramatically different effects on neurofibromin expression in primary cells from individuals with NF1. One group of individuals with NF1 harbored >70% reductions in neurofibromin expression after a single germline mutation regardless of the cell lineage. The clinical importance of differential neurofibromin expression caused by a single germline mutation is especially germane to the interpretation of Nf1 GEM studies that focus on phenotypes dictated by NF1 gene heterozygosity, such as behavior and learning. All NF1-patient fibroblasts, iPSCs and NPCs exhibited high levels of RAS activity, regardless of the level of neurofibromin expression. This indicates that the RAS-GAP activity of neurofibromin is it is comparably impaired in all individuals with NF1, irrespective of the nature or location of the germline NF1 gene mutation, and is thus highly sensitive to NF1 gene mutation. Low hippocampal DA levels and downstream signaling, as measured by reduced DARPP-32 phosphorylation, are associated with impaired spatial learning in mice.

Disclosed herein are methods for diagnosing cognitive and behavioral disorders in subjects with neurofibromatosis type 1 (NF1). In particular methods are disclosed for assessing neurofibromin expression, dopamine expression and phosphorylation of DARPP-32. Reduction in expression of these biomarkers results in impaired memory and behavioral disorders. Since cognitive problems in neurological disorders can be difficult to identify, particularly in non-verbal or young children, predictive molecular biomarkers including neurofibromin, dopamine and phosphorylated DARPP-32 provide especially useful for the early diagnosis of these problems and the appropriate treatment of affected individuals.

In view of the above, it will be seen that the several advantages of the disclosure are achieved and other advantageous results attained. As various changes could be made in the above methods without departing from the scope of the disclosure, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.

When introducing elements of the present disclosure or the various versions, embodiment(s) or aspects thereof, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of the elements. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements other than the listed elements. 

What is claimed is:
 1. A method for detecting a behavioral disorder in a subject having or suspected of having neurofibromatosis type 1 (NF1), the method comprising: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a memory defect in a subject having or suspected of having neurofibromatosis type 1 (NF1).
 2. The method of claim 1 further comprising identifying an expression level of dopamine.
 3. The method of claim 1 further comprising identifying phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPP-32).
 4. The method of claim 1 further comprising detecting a point mutation in a neurofibromin exon wherein the exon is selected from the group consisting of exon 18, exon 21 and combinations thereof.
 5. The method of claim 4 wherein the point mutation in exon 18 is c.2041C>T of human Nf1 gene.
 6. The method of claim 4 wherein the point mutation in exon 21 is c.2542G>C of human Nf1 gene.
 7. The method of claim 1 wherein the behavioral disorder is selected from the group consisting of attention deficit/hyperactivity disorder (ADHD), autism, learning difficulties, and combinations thereof.
 8. A method for detecting a cognitive impairment in a subject having or suspected of having neurofibromatosis type 1 (NF1), the method comprising: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a memory defect in a subject having or suspected of having neurofibromatosis type 1 (NF1).
 9. The method of claim 8 further comprising identifying an expression level of dopamine.
 10. The method of claim 8 further comprising identifying phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPP-32).
 11. The method of claim 8 further comprising detecting a point mutation in a neurofibromin exon wherein the exon is selected from the group consisting of exon 18, exon 21 and combinations thereof.
 12. The method of claim 11 wherein the point mutation in exon 18 is c.2041C>T of human Nf1 gene.
 13. The method of claim 11 wherein the point mutation in exon 21 is c.2542G>C of human Nf1 gene.
 14. The method of claim 8 wherein the cognitive impairment is selected from the group consisting of a learning disability, attention deficit, autistic-like behavior, visuospatial learning/memory problem and combinations thereof.
 15. A method for detecting altered brain neurofibromin-dependent dopaminergic signaling in a subject having or suspected of having neurofibromatosis type 1 (NF1), the method comprising: obtaining an expression level of neurofibromin in a sample obtained from the subject having or suspected of having neurofibromatosis type 1 (NF1); obtaining a reference expression level of neurofibromin from a healthy subject; identifying a difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin, wherein the difference between the expression level of the neurofibromin in the sample obtained from the subject and the reference expression level of the neurofibromin indicates a memory defect in a subject having or suspected of having neurofibromatosis type 1 (NF1).
 16. The method of claim 15 further comprising identifying an expression level of dopamine.
 17. The method of claim 16 further comprising identifying phosphorylation of dopamine and cAMP regulated neuronal phosphoprotein (DARPP-32).
 18. The method of claim 16 further comprising detecting a point mutation in a neurofibromin exon wherein the exon is selected from the group consisting of exon 18, exon 21 and combinations thereof.
 19. The method of claim 18 wherein the point mutation in exon 18 is c.2041C>T of human Nf1 gene.
 20. The method of claim 18 wherein the point mutation in exon 21 is c.2542G>C of human Nf1 gene. 